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Thursday, 14 April 2011

Sugar and artificial sugar: are they poisonous?

Yesterday some of you may have noticed an article about sugar potentially being a poison in The New York Times. So why is it, you might ask, that I get to write an editorial about it? Because it's my blog and I must be one of the only people in the world who is actually angered by this article. And WHY am I angry, you ask. Because sure, sugar is not the healthiest thing one can eat, but implicating that is a "poison" responsible for the obesity-related health problems in the US is ignoring the real issue.

Educated people in the US (and Denmark), (aka, those people who like what white people like, yeah yeah I've been know to be guilty of this, too) love blaming problems on dietary imbalances and finding fads to turn life around. This will anger over half of my readers, but I am thinking along the lines of the paleo diet and gluten intolerance.

Bare with me (edit: SR just pointed it, I should only use "bare" with me when talking to him and otherwise it's the animal, "bear". It always confuses me!). Sugar is not a poison. But when people sit around all day without exercise and eat foods with added sugar or, even worse, high fructose corn syrup, they get fat and thus develop health problems. No one is denying that. But the real problem is life-style. Sugar is just not very filling, so when people eat it, they tend to simply want to eat more because they don't get full and the problem is exacerbated. But let's take someone who exercises. For example, SR. He has exercise as a part of his daily routine, plus when he works out, it is fairly intense. He eats sugar (candy) constantly! It disgusts me since I know it would make me feel like crap, but will he develop diabetes or heart disease from it? No. Because both exercise and our muscles (yes our muscles are also glands!) keep our blood sugar regulation so amazingly finely tuned that eating a lot of sugar really has no effect other than making you feel kind of tired and crappy. Contrast this with smoking, which truly is toxic at the cellular level. Sugar is simply not toxic. But it can make you fat.

There are people out there who try to blame our society's health problems on fructose (The Healthy Skeptic comes to mind, who I have had angry words with on a few occassions). This is turn leads educated people to do things like not eat fruit because it has fructose in it and thus feel themselves superior to others. Well, guess what? Fruit is healthy! And then bread. Poor bread. There is nothing wrong with bread as long as it is eaten as part of a balanced diet and as long as one is physically active.

I am so frightened of what will happen to Natti and The Lorax and Finnbjørn when we move to the US. They will be forced into that sedentary American lifestyle and suffer for it. I have already told SR my plan of the morning boot camp where the kids and I go out running an hour before school just so they can survive America.

Scientists, educated people, health care workers, I appeal to you, stop blaming sugar and bread for health problems in our society and take a look at the bigger problem which is the sedentary lifestyle. Get off of your high paleolithic horses and get real.

Paleolithic Horse at the Caves of Lascaux.

Ahhh. That felt good.

Edit: As long as we're talking about all things Paleolithic: what is the big difference between now and the Paleolithic Era? The size of the human population. The total population now (6.91 billion) is approximately 1,382 times what it was during the Paleolithic era (5 million)! And why is that? The farming of grains! Yay grain. Does anyone who adheres to The Paleolithic Diet honestly believe it is sustainable at a worldwide level??? No way! It is a HUGE use of resources for people in developed countries to eat Paleolithically. Shouldn't a diet both be healhty and sustainable?

Now, onto diet soda. Or should I call it artificial sweeteners? What I want to talk about is a study that was in the American Journal of Clinical Nutrition last June. It was a large Danish study that was actually very well-written. It found that the more diet soda a woman drank, the more likely she was to give birth prematurely. In fact, if a woman drank 4 or more diet sodas a day, her odds of premature birth was increased by 1.86. This is more than if a woman smokes. Amazing, really. And scary for a mom-to-be who likes diet soda. Plus this is just the kind of study the media would L-O-V-E. But what is the catch? Why do I even mention this? Because they played with their data to get a significant result. And if one considers how a study like this could play with a pregnant woman's psyche, it is sickening that the authors would do this to get published. But, as a researcher myself, I know how tempting rationalizations can be, and I am hesitant to blame them, per se. But here were the ingredients of their "fudge":

1. They reported their results in odds ratios rather than relative risk. When looking a prospective cohort, one should report in relative risk unless the expected outcome is exceedingly rare. There is around a 12% chance of premature birth in the developed world, which is not exceedingly rare, so they obviously did this to make their results significant.

2. They broke their analyses up into subgroups when the results weren't significant in the large group: They considered diet soda and other diet beverages two separate things even though they mostly are both sweetened with aspartame. They only did this because all artificially sweetened beverages taken together did not have an effect on premature birth.

3. Just like in the case of sugar, they do not fully address the real problem - socioeconomic class. If there is one meaningful risk factor that has been found for premature birth, it is that. Take a look at this graph, bearing in mind that there is NO increased risk for premature birth in Africa compared with the US (ie it is not genetic).

This is a graph from the CDC. It shows percentage of "late" premature births by race and that is why the "all births" line is only just over 6% and not the 12%, which I quoted above for all premature births.

The New England Journal's review article on "the enigma" of premature birth summed it up best: "Numerous epidemiologic studies have shown the association of poverty, limited maternal education, young maternal age, unmarried status, and inadequate prenatal care with increased risk of preterm birth and low birth weight."

And women who drink more than four glasses of diet soda a day had exactly these characteristics, when they broke down their data, though they failed to control for everything associated with low socioeconomic class and how could they? They have thus not proven causation between diet soda and premature birth (and couldn't with this study design anyway), but have simply shown that drinking excess diet soda goes along with low socioeconomic class, at least in Denmark. Maybe there is something toxic in aspartame, but if there is it is VERY mildly toxic, as they had a huge study and were unable to show a link with all groups of aspartame-sweetened drinks taken together. If anything, they have proven that aspartame is, in fact, not very toxic.

What about me personally? Well, funny thing is, just because of how they taste and make me feel, I've cut down a lot on both refined sugar and artificially sweetened products since getting pregnant. And I have to admit I feel better for it. But when considering the of effects sugar, I am simply saying: be realistic and ---take it with a grain of salt!

Running song of the day: An oldie but a goodie: Cigarettes and Red Vines by Aimee Mann (you tell me which one is the toxin)

12 comments:

I go a lot further than you do - there's not much wrong with high fructose corn syrup, as long as you don't live on it. By law, it must be at least 50% glucose, maltose and maltodextrin and less than 50% fructose (it's usually about 5%). Honey is 40-60% fructose and 60-40% glucose, but it has a few minerals. Agave nectar is 100% fructose syrup with a tiny amount of minerals. It really bothers me that people will anathematize corn syrup and then say they only eat natural things like agave nectar, or worse, stevia (which will continue to scare me until someone does long-term studies).

I think you're totally right! Sugar is only poisonous if you eat tons of it and don't burn it off. I hate how carbs in general are single-handedly blamed for obesity. It's more about total calories and exercise.

I think your kids will be fine. Whether a kid is overweight or not seems to be dictated by what the parents provide them, be that food or activity choices. Since your kids are young, you have pretty much total control over that stuff. :) Boot camp sounds like fun, sign me up!

try not to worry too much about bringing your kids up in america.. it's all about the culture you create for your family. I was raised in the US (don't live there anymore but thats another story) and I was involved with lots of sports growing up. My parents were athletic and my brother and I took part in both competitive team sports and plain old fashioned running around outside, having fun.

(we also had homecooked meals every night, I'm sure that played a role too)

as an adult, I am still involved with both team sports and running. I have never been overweight in my life. I don't know if this is a coincidence or not, but all of my friends who are overweight as adults have sedentary parents. I really think its a learned behavior.

one thing I wanted to comment specifically on, I don't know if you were joking about the boot camp thing, but if you weren't I'd say it sounds like a surefire way to get your kids to resent exercise. my dad forced me to practice piano for an hour every day, and it was the cause of endless arguments and fights. I couldn't wait until I was 'allowed' to quit. As an adult of course, I really regret quitting and can now see that he was trying to do it for my own good, but forcing a kid to participate in a specific activity can lead to resentment. I'm sure if you encourage your kids to participate in sports that they enjoy, and go on family runs maybe in a non bootcamp type way (ha), you will have nothing to worry about.

I know what you are saying about the bootcamp. But I am genuinely worried about raising two boys who are going to be forced into sitting in school all day 8am to 3pm with very little recess and expected to concentrate. If they can't get exercise on the way to school, they they'll have to get it beforehand. And, yeah, I'll do my best to make it fun, but otherwise they'll end up like all the other boys with "ADHD" and that is in quotes because MOST boys have absolutely nothing wrong with them other than needing to get outside and run around.

I totally agree about lifestyle. Totally! I hate to admit, I am a bit like your husband with the candy love, but my exercise love helps balance it out :). In moderation, sugar should not be poisonous to the body, BUT.... I do have to say it is poison to the teeth! So no, the doctors should not be falling back on this argument, but the dentists should. Anyway, a "mostly healthy" diet and daily exercise would probably rid the world of most of its problem - physical and behavioral.

Hey SLG, you say our bodies "keep our blood sugar regulation so amazingly finely tuned that eating a lot of sugar really has no effect other than making you feel kind of tired and crappy".... wouldn't this in itself lead to long term health issues like insulin resistance? Although agreed, exercise will help stave off this effect as the body is using the sugars so yes lifestyle is very important. Personally though, reducing the amount of sugar in my diet has been key to reducing hypoglycemic symptoms between workouts. I do agree with you that blaming sugar for our obesity crisis is wrong - it IS a part of the problem though simply because it is so much more prevalent in our food than it was say even 40 years ago....and our lifestyles are more "bum in seat" than they have ever been. As you know, I am one of your horrifying Paleo-triallers...I cannot eat bread without feeling sick. Same with pasta. I have done trial and error and for sure I DO have an issue with some foods. Something about wheat, though it isn't the gluten. I do suffer waaay fewer symptoms without grains - but that is just me; I will always believe that what we put into our mouths influences our body; pretty sure you may agree with me there - so surely a "blaming a dietary imbalance" could put one on the path to a health solution and be correct?

To skip a bit sideways off topic - For whatever reason (excess processing? additives? GM wheat ? - which you may not have in Denmark because they are smart enough to avoid Monsanto grains) there seems to definitely be an increase in food sensitivities over here and in the western world...that is what I would love to get to the bottom of. I mean, when I went to school, heaps of kids came to school with PB sandwiches. These days...kids are keeling over with allergic reactions from nuts, dairy, eggs, soy etc. Maybe it's not food thats the issue, maybe it's a toxic environment with chemicals everywhere...regardless I hate putting any extra chemicals into my mouth - and most definitely artificial sweeteners is on that list...thanks for the comment on my blog too. We can agree to disagree on some food things :)

Grace, I TOTALLY agree about teeth and so glad you brought it up. With a husband who loves rewarding our kids with candy on the weekend, I have become a tooth-brushing drill sergeant. It is so important! - especially here in Denmark where the flouridation must be different than in the US because all the Danes have teeth like Brits :P. But yeah, doctors, too need to be VERY aware of it because it is a major cause of pain for people in adult life if they haven't been careful. (BUT this issue, too, is inextricably linked to socioeconomic class and must also have a lot to do with regular visits to the dentist).

Cherelli,

Yay! Thank you for not running away angry. I love an intelligent discussion. I totally agree that people need to find what works for them. For us, it is unrealistic to go without bread. But for me simply adding fat and protein and cutting down on sugars HAS given me extra energy. No doubt about it. But the whole "can't eat bread without feeling sick" is what freaks me out! Just because I know how far it can go - there are people in Denmark who don't allow their kids to eat any bread or sugar and some of these kids have been admitted to the hospital with malnutrition because they don't eat when the other kids get snacks, etc. It's the kind of diet that just doesn't fly in Europe, where kids all bike or walk to school and are done with school at 1pm to play around. They burn way too many calories for such a restrictive diet.

The allergy topic fascinates me, too. Part of it is overdiagnosis. I have done a lot of reading into glucose intolerance and the diagnostic criteria are vague and has begun to be used as a waste-basket diagnosis for what previously was irritable-bowel syndrome.

The current theory on the increase in allergies in the Western World is "eating too clean". I'm sure how you've read all about that kids growing up eating food direct from their own farm don't tend to get allergies. It has to do with where the immune system is directed from a very young age. If we are exposed to parasite and bacteria from very young on, our immune system is used in a productive way and we avoid both auto-immune diseases and allergies. My mother-in-law disagrees, but I don't wash fruits or vegetables unless there is actually something visibly gross on them.

I'm really surprised to see you object to the charge that fructose is poisonous. The biochemistry is pretty clear. Specifically, there is no feedback mechanism that prevents fructose from immediately being metabolized and the pieces entering the TCA cycle. Fructose is very good for rapidly regenerating glycogen stores in the liver, so if you've run hard and long, maybe it's not a bad thing on those days. But most people just don't work out that hard, and the fructose just goes to overfilling the liver glycogen stores and then goes to liver fat stores. Overcarbing, maybe particularly with fructose, leads to fatty liver, high triglycerides, small dense LDL, insulin insensitivity, diabetes- all of the rampant diseases we see these days.

Here's a quote from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC552336/?tool=pubmed"Of key importance is the ability of fructose to by-pass the main regulatory step of glycolysis, the conversion of glucose-6-phosphate to fructose 1,6-bisphosphate, controlled by phosphofructokinase. Thus, while glucose metabolism is negatively regulated by phosphofructokinase, fructose can continuously enter the glycolytic pathway. Therefore, fructose can uncontrollably produce glucose, glycogen, lactate, and pyruvate, providing both the glycerol and acyl portions of acyl-glycerol molecules. These particular substrates, and the resultant excess energy flux due to unregulated fructose metabolism, will promote the over-production of TG."

Take a look at Lustig's lecture on Youtube http://www.youtube.com/watch?v=dBnniua6-oM It's long, but very enlightening. He treats obesity, and wonders why children, even 6 month olds are obese. It's obviously not all gluttony and sloth. He gives a good accounting of our historical consumption of fructose and explains the biochemistry.

A piece of fruit or so (say less than 25g fructose per day) is probably fine for most people, whether they are active or not. This is the amount people ate before WWII. The problem is that fructose is so prevalent and is hidden in almost all prepared foods. People eat a lot more than 25g now.

Anyway, there is lots more evidence.

As for teeth, I can say my family saw huge improvements in tooth and gum health when we stopped eating so much carbs.

Cynthia - wow! Never apologize for a long comment. I love it. I have really forgotten all about fructose metabolism from Biochmestry and honestly don't regret that. But I refuse to buy that fruit is "poisonous" or that carbs in general are bad. Humans have survived on nearly carbs alone since the Neolithic era. Only rich people could eat meats. No way carbs explain the current obesity epidemic. Sure, eating too much and not exercisig - yeah. The problem is how sedentary life has become and how readily available food is.

You pose a very interesting question though about obese 6 month olds. I had to think for a bit about that. But I guess my big question is - why aren't they being breast fed? And if breast feeding weren't possible, they should only be receiving formula at six months. Somethins is absolutely wrong if a 6 month old is sitting eating a pizza. I guess I fail to see how that gets the point across about fructose.

Plus remember that mothers who don't exercise while pregnant and gain too much weight (and maybe get diabetes) produce super-sized kids. Fructose is not the main culprit- not exercising and overeating; those are the culprits!

Hello from Rude Skov

Photo by Stine Sophie Winckel

...

My name is Tracy. I am a physician scientist from the USA, living with my husband and two young boys in Denmark. I work as a post-doc fellow at Næstved Hospital. I have a scientific interest in vision loss, vision loss during exercise, exercise, running during pregnancy, MAF training as well as nutrition and health for athletes. I also have a love for music, physics, statistics, cycling, yoga, cross-country skiing, bla bla bal.

I was a member of Team USA at the IAU World Championships in Ultra Trail Running in 2013 in Wales. I am now training to run with Team Denmark at the IAU World Championships in Annency, France in May 2015.